The government’s recent decision to test everyone returning to Nepal from abroad within five days of their arrival has been criticised by public health experts.
The decision does not minimise the risk of transmission as many infected people may test positive only after at least eight of being exposed to the virus, they say.
“We will soon make available polymerase chain reaction tests for all returnees from foreign countries after they spend up to five days in holding centres, and send them home,” Dr Roshan Pokhrel, chief specialist at the Ministry of Health told the Post. “We will also ask them to stay in strict home quarantine for 14 days after getting home.”
The ministry’s decision, announced on Sunday by spokesperson Dr Jageshwor Gautam, comes as the number of people coming to Nepal from abroad has dwindled to less than 3,000 every day.
“The median incubation period of coronavirus is five days, which means half of the infected people can be diagnosed only after five days,” said Dr Anup Subedee, an infectious disease consultant. “Five days is too short a period for PCR tests. The results may come negative even for people infected with the virus.” It can take upto 14 days for a positive test result in the case of some people already carrying the virus.
“Testing all returnees is a good thing, but the virus may not be detected in five days,” Dr Sher Bahadur Pun, chief of clinical research unit at Sukraraj Tropical and Infectious Disease Hospital, told the Post. “Those Infected people but tested negative in five days can easily pass virus in the communities. ”
An infected person can spread coronavirus only about a week after contracting it as the incubation period (time between the exposure and symptoms onset) for the virus is on an average five to six days. But the presence of the coronavirus can be detected in up to 90 percent of the infected people, if tested they are tested after eight days of exposure, said Subedee.
“If the government can’t place them [returnees] in quarantine for 14 days, it should at least keep them from eight to 10 days to cut the risk of local and community transmission,” he added.
At present, authorities send Nepalis flying into Kathmandu to holding centers, from where they are sent home on reserved buses. Chances of transmission of the infection inside the bus and in communities is already high now, experts say.
The new provision is going to increase the risk further, they add.
“Earlier, hundreds of people got infected in makeshift quarantines set up in various districts throughout the country,” a senior official at the Covid-19 Crisis Management Center, told the Post, on the condition of anonymity as he wasn’t allowed to talk to the media. “Now [with the government’s new plan] holding centers will become the new virus spreading centers.”
At least eight Nepal Army personnel managing the holding centers in Kathmandu Valley have already tested positive for coronavirus. Dozens of others returning from abroad and staying in such centers waiting to go home have also tested positive.
“The whole concept of holding centers is wrong, as people returning from different countries on separate flights are being kept in one place,” the official said. “Even those who are not infected are also getting infected at these holding centers.”
“Fourteen days of quarantine should be made mandatory, and attention should be paid to improve the condition of quarantines.”
Some of the returnees staying at the holding centers are seeking tests on their own at Tribhuvan University Teaching Hospital, Bir Hospital and Patan Hospital. But authorities concerned are not bothered to stop them from going out on their own even after doctors at the Tribhuvan University Teaching Hospital recently drew their attention over the risk of transmission through such people.
The administration offices in the districts bordering India have been sending people returnees from India directly to their home districts on public vehicles. As they stay in quarantine only after reaching their own district, there’s a high chance of transmission of the virus,Health Ministry officials say.
“Quarantine facilities should be improved and established near border crossings,” an official at the Health Ministry told the Post on the condition of anonymity as he wasn’t authorised to talk to the media.
Around six percent of the total Covid-19 cases in Nepal have been found in people who don’t have a history of travelling to disease-hit areas of coming into close contact with an infected person, according to the ministry.
As of Monday, 17,844 people have tested positive for Covid-19 in the country and 40 deaths have been attributed to the disease.
Frequently asked questions about the coronavirus outbreak
UPDATED as of September 22, 2020
What is Covid-19? Covid-19, short for coronavirus disease, is an illness caused by the coronavirus SARS-CoV-2, short for severe acute respiratory syndrome coronavirus 2. Common symptoms of the disease include fever, dry cough, fatigue, shortness of breath and breathing difficulties. In severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.
How contagious is Covid-19? Covid-19 can spread easily from person to person, especially in enclosed spaces. The virus can travel through the air in respiratory droplets produced when a sick person breathes, talks, coughs or sneezes. As the virus can also survive on plastic and steel surfaces for up to 72 hours and on cardboard for up to 24 hours, any contact with such surfaces can also spread the virus. Symptoms take between two to 14 days to appear, during which time the carrier is believed to be contagious.
Where did the virus come from? The virus was first identified in Wuhan, China in late December. The coronavirus is a large family of viruses that is responsible for everything from the common cold to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). After an initial outbreak in Wuhan that spread across Hubei province, eventually infecting over 80,000 and killing more than 3,000, new infection rates in mainland China have dropped. However, the disease has since spread across the world at an alarming rate.
What is the current status of Covid-19?
The World Health Organisation has called the ongoing outbreak a “pandemic” and urged countries across the world to take precautionary measures. Covid-19 has spread to 213 countries and territoriesaround the world and infected more than 31,405,983 people with 967,505 deaths and 22,990,260 recoveries. In South Asia, India has reported the highest number of infections at 5,557,573 with 88,943 deaths. While Pakistan has reported 306,304 confirmed cases with 6,420 deaths. Nepal has so far reported 65,276 cases with 427 deaths.
How dangerous is the disease?
The mortality rate for Covid-19 is estimated to be 3.6 percent, but new studies have put the rate slightly higher at 5.7 percent. Although Covid-19 is not too dangerous to young healthy people, older individuals and those with immune-compromised systems are at greater risk of death. People with chronic medical conditions like heart disease, diabetes and lung disease, or those who’ve recently undergone serious medical procedures, are also at risk.
How do I keep myself safe? The WHO advises that the most important thing you can do is wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizers with at least 60 percent alcohol content. Avoid touching your eyes, nose and mouth with unclean hands. Clean and disinfect frequently used surfaces like your computers and phones. Avoid large crowds of people. Seek medical attention if symptoms persist for longer than a few days.
Is it time to panic?
No. The government has imposed a lockdown to limit the spread of the virus. There is no need to begin stockpiling food, cooking gas or hand sanitizers. However, it is always prudent to take sensible precautions like the ones identified above.
Arjun Poudel is a health reporter for The Kathmandu Post. Before joining the Post, he worked for Sagarmatha Television, Naya Patrika, Republica and The Himalayan Times.
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